Victims Navigate Aftermath of Sexual Assault

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April 25, 2013

Walking past the place where she was raped, Emily still suffers anxiety attacks.

Emily, whose name has been changed to maintain confidentiality, said that in the months after her assault, she battled depression, felt isolated from her friends and had trouble sleeping. After Emily overdosed on the sleeping medication Ambien, the University labeled the incident a suicide attempt and mandated she take a two- to three-semester medical leave.

Victims of sexual assault face psychosocial repercussions that reach into their personal and academic lives. Finding ways to cope with their experiences, some take leaves of absence and others remain at the University, taking advantage of available resources.

Out of mind 

Anna and Jacob, whose names have been changed to maintain confidentiality, were both sexually assaulted at the beginnings of their first years at Brown, but it took months for them to come to terms with what happened.

Anna said she did not think about the incident after it occurred, leaving mention of her assault out of the journal she kept that year. “If I write it down, it’s true, and I don’t want to deal with that,” she remembered thinking.

She did not realize she had been sexually assaulted until nearly a year later, she said, adding that she has still told only a few people a year and a half after the assault.

Jacob said he “buried everything that was going through (his) head.” He told his friends he “hooked up with someone,” but it took five months for him to label his experience as sexual assault.

American culture suggests people should “try not to think about” traumatic incidents when they occur, said M. Tracie Shea, professor of psychiatry and human behavior.

But the “time heals all wounds” philosophy “doesn’t work for serious trauma. It just doesn’t work,” she said.

Director of Psychological Services Belinda Johnson said the amount of time it takes for victims to feel ready to talk about their experiences varies.

Once victims contact Psych Services, they can meet with Bita Shooshani, coordinator of sexual assault prevention and advocacy, or a campus psychotherapist, Johnson said. Psych Services staff members provide “support and information” for victims of sexual assault but do not force them to take any particular action, she said.

Students are provided seven free sessions with a Psych Services psychotherapist per academic year, which can help victims move “beyond the immediate crisis situation,” Johnson said. Some students may want to meet with psychotherapists for additional sessions, which can be arranged case-by-case, Johnson said. After the victim is stabilized, a campus counselor can recommend off-campus therapists.

But Emily said it took too much effort to look for a therapist on her own.

Psych Services “kept on throwing me all these lists of therapists I could call, but … it took so much energy just to go to class and try to do my reading,” Emily said.

Johnson said Psych Services is willing to help victims with the groundwork when searching for therapists, but most clinicians only allow the patient to schedule appointments.

“I just did not relish the idea of picking up a phone and calling some random stranger,” Emily said.

Aftershocks

Emily said she felt like “a zombie” in the week after she was raped.

“Immediately after the assault, it’s not uncommon for people to be in shock,” Johnson said. “Other people will become numb … and not allow themselves to feel anything for a while.”

Post-traumatic stress disorder, a common consequence of sexual assault, is characterized by this “numbing” of emotions, and victims may avoid reminders of the trauma — particular people, places or smells — and suffer from “re-experiencing symptoms” like flashbacks, nightmares and recurring memories, Shea said. Victims often resort to coping mechanisms that do more harm than good, Shea said. Avoidance, for example, can disrupt their daily routines.

About 46 percent of women and 64 percent of men who are assaulted “will meet criteria for PTSD,” Shea said.

Jacob said thinking about his perpetrator’s presence or seeing him around campus triggered anxiety attacks.

“I would suddenly just feel very nervous and on-edge and very tense,” Jacob said. “I’d be afraid that he would sort of try to acknowledge me in some way or contact me or touch me.”

Victims can also experience dissociation, “where a survivor sort of mentally goes somewhere else,” said Rebecca Loya, postdoctoral research associate in public policy, who studies the economic implications of sexual violence. “It’s a defense mechanism in order to survive a really difficult experience,” she said. Dissociation can impair a victim’s ability to recount the event to the police in the immediate aftermath of the assault and can interfere with everyday life later on.

If a Psych Services psychotherapist thinks medication will help the student, the therapist will send him or her to a school psychiatrist, who can prescribe medication, Johnson said.

Emily, who said she has a family history of depression and anxiety, occasionally took Ambien, which her doctor had prescribed to her prior to the assault. She began taking it daily after she was raped, she said.

The school psychiatrist prescribed her the antidepressant Prozac, starting her on a 20 milligram dose before upping it to 100 milligrams — “a high dose very rapidly,” Emily said.

“It was kind of like every single thought I had was negative,” Emily said. “I felt like I didn’t want to die, but if I got run over by a bus, it wouldn’t be the worst thing.”

One night when Emily was having trouble falling asleep, she took too much Ambien, she said — three or four pills. She said she felt “zonked out.” Realizing she might not wake up, she reached out to her friends.

Social interactions 

Victims’ responses to assault can disrupt their relationships with others, but those relationships are often crucial to moving forward.

After experiencing an assault, some victims try to appear androgenous by wearing many layers of clothing or losing weight, while others turn to promiscuity, said Francis Haines, a Psych Services psychiatrist.

This may be part of the process of “trying to understand what’s happened to them,” he said.

Anna entered one “destructive relationship” after another after she was assaulted, she said. “Sex became a really big thing in my life,” Anna said. “It was sort of me owning what had happened.”

“There may be a self-punitive aspect” to victims’ behaviors, Haines said, adding that they often blame themselves.

The responses of people close to the victim can aggravate feelings of guilt and uncertainty about whether they were actually assaulted, he said.

“People can end up victimizing the victim,” Haines said, by asking questions like, “What were you doing out at that hour? … Why didn’t you take more precautions? What were you wearing?”

Haines said sexual assault can instill a sense of “isolation and avoidance of others” in victims.

“It can be extremely difficult to be intimate in any kind of way with anyone,” he said.

Anna said she struggled to trust men in intimate settings following her experience. She recalled an incident in which she refused to sit next to a male friend on her bed, because she was “so freaked out by guys and so mistrustful.”

If the victim is surrounded by supportive relationships, it is easier to cope, Johnson said.

But even well-intentioned friends and family who try to help, either by pretending the assault did not happen or by trying to force victims to talk about their experiences, may act in ways not conducive to the victim’s healing, Shea said.

Catherine, whose name was changed to maintain confidentiality, was sexually assaulted during a University summer session. When she took a leave in the middle of the following fall semester, she chose not to return home due to her complicated relationship with her mother, she said.

“My mom kind of misinterpreted everything, and she didn’t know how to be supportive of me,” she said.

“The bulk of my support network was up here with my friends,” Catherine added. She stayed in Providence while on leave.

Academic consequences

The psychological effects of sexual assault can pose challenges to students’ academic careers. Associate Dean of the College Carol Cohen, who serves as the student support liaison to the Office of Student Life, said she has seen “the whole gamut” of responses to assault. While some victims “might perform super well academically as a way of compensating,” others “might completely grind to a halt.”

Anna said she focused on succeeding in school, finding comfort in its familiarity. But sometimes flashbacks would make completing assignments difficult, she said. “I’d have to go do a lab, or I’d have to go write something … and I would be having a flashback, breakdown basically,” she said.

Emily also struggled with her course work after her assault. “It was really tough to keep up when I was going through this realization process,” she said. “I was staring at my work and just not processing it.”

Cohen helps victims review and adjust their academic obligations and notifies faculty members when students have experienced trauma, she said, though she does not reveal the nature of the incidents.

“We would look at the whole range of possible accommodations — extensions on assignments, delayed exams, incompletes and even the possibility of a reduced course load if that seems to be called for,” she said.

The semester after her assault, Catherine had trouble focusing on academics.

“I remember studying in the (Sciences Library) once and seeing (my perpetrator) come down the stairs and I just couldn’t do it,” she said. “That was when I realized I couldn’t do school.”

Taking leave

Victims of sexual assault “very occasionally” take medical leaves, Cohen said, adding that the University never forces students to leave for health reasons.

But Johnson said in rare cases, the OSL, sometimes with input from Psych Services, mandates a medical leave if a “student is in a psychological state where others are in danger or … they can’t be relied on to take care of themselves.”

Emily said she was forced to take a medical leave from the University after administrators labeled her Ambien overdose as a suicide attempt, but she said she did not perceive it that way.

Emily said Johnson and the dean in charge of her case told her she would be unable to return for two to three semesters.

“Why am I getting kicked out for something that happened to me?” she said she asked Johnson.

Emily returned home and was diagnosed with PTSD. She said she felt unhappy leaving, but her anxiety attacks became less frequent.

Her request to return was denied when she reapplied before the University’s recommended time away had passed.

Though there were “a lot of positive indicators that I was pretty high functioning,” Emily said, University administrators told her she was not ready. She was allowed to re-enroll after she and her father appealed the decision.

Catherine decided she wanted to take a leave midway through the fall semester following her assault. She originally planned to return in the spring, but University administrators told her if she wanted to take time off, she would need to leave for two semesters, she said.

“The extra time for me has definitely helped,” Catherine said, noting that time away from the University has enabled her to focus on her needs without the stress of school. But, she added, “I don’t think people should be forced into that if they don’t want to.”

Coming to terms

“I’m excited to get back into … academic mode” when back in classes next fall, Catherine said. “I have found that my legitimate love of learning has come back and my intellectual curiosity is still there,” she said.

Jacob said reporting his assault to the University gave him a sense of closure, despite the emotionally taxing hearing process.

Today, Jacob is involved in Sexual Assault Peer Education, which aims to raise awareness about sexual assault on campus.

“I felt like it was my responsibility to help end the culture of silence,” he said.

Emily said she felt judged by her friends upon returning from medical leave but has since formed new friendships. She is now in a relationship but said she still has “trouble sleeping next to anybody.”

The anniversary of her assault was difficult but not incapacitating, Emily said.

“For the most part, I’m happy now. … But it took me a good year and a half after it happened to feel content and normal and like myself,” Emily said.

For Anna, a big moment in her healing process came when she was able to tell her boyfriend about being sexually assaulted, she said.

“You’re recovered, but it’s not gone,” she said. “It’s just sort of like a scar, it’s just like a really deep gash … and then time passes and it starts healing and eventually it doesn’t hurt anymore — but it’s still there, and it can kind of hurt a little and it kind of looks bad.”

Source: http://www.browndailyherald.com/2013/04/25/victims-navigate-aftermath-of-sexual-assault/